issues with CAHMS psych

[Bonkerz]

Just wondered if any of you have any experience like im having right now.

Ds was diagnose in Sept 2008 with autism, ODD and anxiety. this was after a huge battle with CAMHS to get the ADOS test and after the psych said DS had no problems at all and it was my parenting to blame, and i had to place a formal complaint against the psych.
We still have the same psych now and he has been ok untill last month.
About 6 months ago we put DS on Risperidone which worked brill but the effects have now worn off and in Aug the Psych agreed DS would go on Stratterta and he told DS to prepare himself for a med change.
We went for an appointment 2 weeks ago which we thought was to get the new meds and the psych actually told my son that he CHOSE to physically hurt people and that he was going to take him off all medication in Nov at next appointment and told me i should try disciplining my son!
In shock i left the appointment and rang DSs school the next day. DS goes to a private priory school for autistic children and is in a class of 3 children with 1:1 support and they use lots of strategies with him and he has done brill since starting there in oct 2008. The school were shocked at what had been said to myself and my DS and agreed they would support me 100% and divulge all info to CAHMS.
YEsterday i recieved a letter from the psych which was CCd to me and was addressed to a school my son does not attend asking for info on DSs behaviour, the diagnosis on this letter was wrong and it was sent to a completely different doctor via CC too but it was my sons name and date of birth on the letter!
I rang the psych and had a bit of a rant at him and he blatently admitted to getting my son confused with another child.....i then asked him if he had known who he was speaking too in the meeting when he was so harsh on my 10 year old DS and he admitted he had been negligent and owed me some apologies and explanations!!!!!!!!!!!!!!
Im absolutely fuming.
Since the appointment my sons self esteem has hit an all time low, he doesnt know whats going on with his medication and school have reported his 'crisis' behaviour has hit an all time high with him spedning over 9 hours per school week in the calm room.
I have an appointment on 24th November to meet with the psych to discuss all of this and the school have rang him to offer him a meeting at the school so he can see first hand the school and the behaviour.

Can the Private school help you to change the psych?

I would make a complaint about the Letter being sent to the wrong school. You can say that was a breach of confidentiality. And a serious mistake that the psych had got two patients mixed up.

Then say to the CAMHS that as there is a breakdown of trust between your DS and you with the psych, Request a change of psych. Secondly, go to your GP and ask her to put your DS back on the meds which you and DS were happy with. Consultants/psychiatrists can only suggest to GPs the meds. The GP has the authority or final decision. I know, because I have seen that happen in the last three months.

Bonkerz

That's truly shocking. You've described a whole host of very unprofessional if not dangerous behaviours by this Pysch.

Sadly our own experience of CAMHS was very mixed (to say the least0. Our initial Pysch was utterly crap and it was only when I raised a complaint that we managed to change to a decent Pysch.

if I were you....

Look on the GMC website and see what this Pysch's specilaism is - some are not Child and adolescent Pyschs at all but 'general' psychs who may have littel expertise in dealing with children (yes- it's unbelievable but it happed to us).

The site will also tell you when and when the Pysch qualified so you can judge their competence. I hope I am not flamed for saying this because it is based on my own personal experience with one, but I have found that Pyschs that trained outside the UK can have (cultural) different views on mental health issues and are not always up to speed in the same way as UK-trained Pyschs are. That was our experience.

Then I would ceratinly raise a formal complaint to the Head of the Trust in writing and ask that you be reassigned to another Pysch.

To have written to a 3rd party (school) without your consent is not acceptable. To have written to the wrong school about the wrong child is totally incompetent.

To have told your son that he is to blame is just totally outrageous.

You are now left without any meaningful professional input and that too is not acceptable. That's why I am suggesting that you ask to change Pyschs immediately.

I would go as far as we ourselves did and tell the PCT that we had no confidence whatsoever in the Pysch and demanded a 'replacement'.

You can also report him directly to the GMC, however the PCT should do that themselves if they have any doubts about his competency.

Best wishes

Linda

You wrote: Consultants/psychiatrists can only suggest to GPs the meds. The GP has the authority or final decision. I know, because I have seen that happen in the last three months.

That's not true.

When a child is referred to CAMHS the CAMHS Pyschiatrist becomes the primary carer for that particular condition and is therefore primarily responsible for deciding the medication.

The GP may take over the role of repeat prescriptions but will not alter the medication without referring the matter back to the CAMHS pyschiatrist under whose care the child remains until discharged back to GP care.

Think about it - a GP is a general gatekeeper. A Consultant Pysch is both a medical doctor and a trained pyschologist. It's the Pysch who is knowledgeable about the various medications for the condition - not the GP generalist.

Oh - and at danger of dominating this thread.

DS was also prescribed Risperidone. It was useless.

He was then prescribed an SSRI which was much more effective at tackling his OCD and anxiety.

That's what I would be asking for.

I disagree. If the GP writes and signs the prescription, then the final decision rests with the GP.

Three months ago a consultant wrote to a GP (which I know about) But the GP decided against the consultants SUGGESTION

If you read the letter from the psych to the GP, you will see that it uses words like "I suggest or I recommend that you put X on Z "

And another thing WETAUGUST, Psychologists do not usually have the qualifications to be able to prescribe medication.

OP, will you please just clarify. Do you see both a psychologist and a psychiatrist at CAMHS.

Normally, psychologists do not have the right qualifications to prescribe meds.

No Lucinda - you are quite wrong. When a child has been referred to secondary care it's the secondary care provider who retains responsibility for the prescribing until such time as the secondary carer refers the child back to primary (GP) care - fact.

I never said that a pyschcologist could write a presciption - they can't. If you read my post correctly you's see that i ststaed that a Consultant Pysch(chiatrist, as we weretaking about prescribing) was a trained medical doctor (which is why he can prescribe but a psychologist can't) and a trained psychologist.

Which kinda puts Psychiatrists a little higher up the food chain than GPs or psychologists.

Wet august. It is you who is mistaken.

All prescribing goes through the GP, otherwise there would be chaos.

Psychologists have different traing and do different degrees from psychiatrists.

I think we can agree that the OP and her son have been treaed badly no matter who prescribed the meds.

I feel sorry for your Ds bonkerz and I would definatly be complaining very strongly.

You could possibly accuse the CAMHS guy of verbal abuse of your DS

Lucinda

I am trying to be patient but you really are talking crap.

Are you seriously trying to tell me that responsibility for medication for MH issues lies primarily with a GP - and not with the 'expert' Consulatnt Psychiatrist?

If so you might as well just sack all teh Consulatnts and pitch up to your local Gp for all meds.

Ds was prescribed melatonin by Consulatnat Pyschiatrist because GO was not permitted to prescribe it. It could only be prescribed by Consultant Pyschiatrist. GP had to get CP's written agreement to continue to issue repeat prescriptions for that particular med.

So who's in charhe in that scenario?

Also I cannot imagine for one momemt that a competenet Gp woudl choose to override the recommendations of someone more expert in the fiweld than himself when it came to prescribing meds for MH conditions.

I don't know where you get your info from but I can only presume you must have experienced a very unique set of circumstances when a GP took it upon himself to ignore specilaist advice. Note the word specilist - a Consulatnt is on the sepcilaist registe - a GP is not.

As for..."Psychologists have different traing and do different degrees from psychiatrists".

Duh - No shit Sherlock?

Guess what - some of us SN parents actually have some knowledge of the roles of pyschologists and psychiatrists in our children's care.

WetAugust...Excuse me for butting in but I think you might be fight a losing battle on this!!

Why - are you another one who thinks that GPs have prescribing responsibiity?

A consultant psychiatrist will write a letter to the GP "suggesting" what meds to prescribe. The patient may be on other meds for other conditions. The GP can, taking into account all factors, decide on valid medical grounds not to conform to the "suggestion" of the consultant. If you do not believe me then phone up NHS direct.

No I just think that the OP must be a sad that her post about her son has turned into a row about who can prescribe and who can't.[hsad]

Lucinda Carlilse I have to agree with WetAugust here. Psychiatrists are medical doctors with a specialist knowledge of (not unsurprisingly) psychiatry.

Psychologists are highly qualified in psychology, but are not medically qualified.

GPs are generalists.

Psychiatrists will start a course of medication, and the GP is asked to continue that prescription. If the GP disagrees with the course of treatment, they can refuse to prescribe, and refer the patient back to the psychiatrist for further review, but that is quite rare.

An example which is slightly different, is that my DD1 has sleep difficulties. The Consultant Paed prescribed Melatonin, then wrote to the GP requesting that she continue the rx.

I am having severe regular migraine. The GP has reached the end of her scope with my medication. She KNOWS that epilim or topirimate would likely help, but she won't rx it without referring me to a neurologist, who can prescribe it in the first instance, then ask her to continue it.

Some medication requires regular blood tests or other monitoring, it is usually the GP who organises or who conducts those tests.

Bonkerz that is shocking, btw.

I hope that you get a good explanation from the Psych.

Bollocks. Any CP will ask what meds you are on before determining which meds he thinks will help the condition.

I sincerely hope I never have cause to visit any Consultant in Lucinda-land. I can imagine myself lying in cardio-arrest while your Consulatnt desperately tries to get through to my very 'umble GP late on a Bank Holiday to ask him whether he is able to prescibe the particular med necessary to resusitate me.

Our letters from CP to GP state things like "I have prescribed x-med".

Oh why am I wasting my time - believe what you want.

A member of my family got a report from a specialist CAMHS unit sent to the GP and it suggested that the GP do blood tests and then prescribe medicationX.

WET august you are wasting your time, because you do not understand the role and responsibility of the GP.

Bonkerz, (hiya!) I certainly would request a change of psych, but would first get him to see your ds and explain that he was wrong and try to undo the damage done initially. Sorry to hear that things are difficult; I imagine that they'll be kicking themselves and you might get some more decent therapy/ whatever from CAMHS out of it.

(Re: the meds issue, here the psychiatrists are the prescribers initially until dosage is stabilised; the GP then takes over, but the main prescriber if very much the psych(not psychologist though, psychiatrist). However, GPs can refuse to give a prescription if they disagree with how much is prescribed - my sister has experienced this. I have never heard of a GP making up a new prescription though )

Oh, and GP only changes the dosage of my son's meds once the psych writes and tells them to. Checks are done by GP but only because they become responsible for ongoing prescriptions; however, they only do this under direction from psychiatrist - my son's letters are not suggestions; they're directions.

WET august you are wasting your time, because you do not understand the role and responsibility of the GP.

I will now break the rules and spirit of the SN Board.

FUCK OFF YOU PATRONISING COW!